Does it Make a Difference Where an X-Ray is Taken?

Q:  Is there any significant difference between an X-ray taken at a chiropractic clinic and one taken in a hospital?

A:  The answer is typically “yes.”  I say typically because the most common region of the body that is X-rayed in a chiropractic clinic is the low back (lumbar spine), and low back X-rays will typically differ. A wrist film (X-ray), on the other hand (no pun intended), would not be appreciably different between the two clinical settings.

The primary difference between a low back film taken in both settings is that the hospital image will generally be taken with the patient lying down, whereas the chiropractor will have the patient standing. The reason for this difference essentially boils down to what the practitioner is trying to determine from the image. The films, chemicals and equipment are all fundamentally the same.

While not always the case, the typical lumbar X-ray taken in the hospital may be used to determine or rule out a possible fracture, infectious process or bone disease, most of which would not be significantly changed by having the patient stand. A typical X-ray taken in the chiropractic clinic will be used to determine postural or structural alterations (in addition to the previous conditions) which might entirely disappear if a patient were recumbent (lying down). Fortunately having the patient stand will rarely obscure the things that your medical practitioner is looking for; so the standing or “weight-bearing” X-ray image arguably reveals more about the patient with low back pain without losing other important information.

One might ask why weight-bearing X-rays are not more common in the hospital setting. Not all patients (especially in the hospital setting) are able to stand still for an X- ray, and standing still is imperative to optimize image clarity. Furthermore, the information revealed on a standing X-ray will not significantly affect the average medical practitioner’s treatment protocol. The same information may be the very means by which I determine what particular technique might be utilized to achieve the greatest benefit to the patient, with the least amount of risk.